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68 Cards in this Set
- Front
- Back
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5 causes of low back pain?
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fx, strain, disc herniation, infection, referred pain
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How many people will need healthcare relating to low back pain?
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80%
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What are the 3 goals of LBP tx?
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hasten recovery, control pain, facilitate rehab
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What % of pts w/ LBP/sciatica will resolve in 6 wks?
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90%
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What % of pts w/ LBP will resolve in 12 wks?
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99%
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What are 6 things in the hx that are ominous for LBP?
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bilateral radicular pain, saddle anesthesia, urinary inconcinence, urinary retention, inc urinary freq, overflow inconinence
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What diagnosis is one of the few LBP emergencies?
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cauda equina sundrome
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What is the tx for cauda equina syndrome?
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w/i 24-48 hrs surgical decompression must be done or neurologic impairment may result
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What 3 things in the hx may indicate fx?
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major trauma, fall from height, female over 50
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What are risk factors for LBP due to infection?
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over 50, under 20, fever and chills, pain worse supine, recent UTI, IV drug abuse, immune suppression
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What is done on PE for possible infection?
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take temp, spinous process percussive pain
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What are risk factors for tumor causing LBP?
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over 50, under 20, unexplaines weight loss, pain worse supine, severe nocturnal pain
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If pulse is weak and rapid and BP low what is indicated?
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retroperitoneal hemorrhage
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Why is the Shober test done?
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to test lumbar flexion
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How is Shober test done?
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mark PSIS, 5cm down, 10cm up, upon flexion the line should stretch at least 20cm
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Why is the Trendelenburg test done?
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to test strength of glut medius indicating compromise of L5 nerve root
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What are 3 etiologies for pos Trendeleburg test?
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disc herination, spinal tumor, intraspinal abcess
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What does straight leg raising test for?
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sciatic nerve pain
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What are 3 causes of pain on spinous process percussion?
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fx, infection, tumor
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What are the 5 reflex grades?
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0=absent, 1=dec, 2=normal, 3=inc, 4=clonus
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What is clonus?
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alternating m contraction and relaxation in rapid succession indicative of disconnect b/t upper and lower motor neurons
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Where is the patellar reflex?
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L4
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Where is the achilles reflex?
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S1
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Where is the superficial anal reflex?
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S2, 3, 4
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What does a + Babinski sign look like?
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dorsal flex of 1st toe
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What are 4 dx's causing + Babinski sign?
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multiple sclerosis, amyotrophic lateral sclerosis, cerebrovasc acciden, brain tumor
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What is grade 0 m strength?
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flaccid paralysis
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What is grade 1 m strength?
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can palpate m contraction but m cannot move affected body part
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What is grade 2 m strength?
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can move body part w/ gravity removed
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What is grade 3 m strength?
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movement against gravity
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What is grade 5 m strength?
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full strength against resistance
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What is cause of grade 3-4 m strength?
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neuralcompression
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What is cause of grade 0-2 m strength?
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CNS problem - CVA, Guillain-Barre syn, MS
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What n inn iliopsoas?
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L1-3
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Inn of quads?
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L2-4
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Inn of hip adductors?
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L2-4
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Inn of tibialis anterior?
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L4
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Inn of ext hallicus longus?
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L5
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Inn of ext digitorum longus and brevis?
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L5
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Inn of glut medius?
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L5
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Inn of fibularis longus and brevis?
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S1
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Inn of glut max?
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S1
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Inn of gastrocnemius and soleus?
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S1-2
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What is tx for SD of L-spine?
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counterstrain for TP, ME, HVLA
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What is cause of LBP on iliospsoas strength testing?
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discogenic pain, appendicitis, sigmoid colon dys, uretal calculi, prostate cx, salpingitis
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What is seen on PE for iliopsoas problem?
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inc pain standing, + Thomas test, + TP medial to ASIS, NN SD L1-2, + pelvic shift, sacral SD, piriformis, spasm
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What is tx for acute iliopsoas problem?
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ice, DO NOT use heat, indirect OMT
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What n for sensation to ant thigh?
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L1-3
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What is n for sensation to medial side of foot?
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L4
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What is n for sensation to space b/t great toe and 2nd?
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L5
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What is n for sensation to lateral side of foot?
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S1
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What is n for sensation to percanal skin?
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S2-5
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What does + valsalva test indicate?
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space occupying lesion in spinal canal
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What does + Naffzinger test indicate?
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space occupying lesion in spinal canal
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How is Soto Hall test done?
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pt supine and passively flex until pain is elicited at site of spinal disorder
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What does Patrick test for?
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sacroiliitis, hip joint dx
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What does + Nachalas test indicate?
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femoral n entrapment or dx
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What are the 3 prone tests for LBP?
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Nachlus test, palpation, strength testing
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What are 3 causes of spinal stenosis?
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hypertrophy of facet joints, Ca++ deposits in lig flavum/post long lig, loss of IV disc height
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What is quality of spinal stenosis pain?
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achy, shooting pain, paresthesias
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What is seen of PE w/ spinal stenosis?
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worsened by ext, osteophytes and dec IV space on imaging
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What is tx for spinal stenosis?
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OMT to dec restrictions and inc ROM, PT, NSAIDS, low dose steroids, epidural steroid inj, sx lamenectomy
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What is pathogenesis of herniated nucleus pulposus?
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narrowing post long lig, usually at L4/5, L5/S1, exerts pressure on n root below vertebra
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What is seen of PE for herniated nucleus pulposus?
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weakness, dec reflexes, sensory deficit in dermatome, + straight leg test, MRI is gold standard
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What is tx for herniated nucleus pulposus?
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few sx candidates, bed rest < 2 days, OMT indirect, HVLA
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What is most overlooked cause of LBP?
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quadratus lumborum m dysfunction
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What supportive care is concern in LBP pts?
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narcotic abuse
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What 2 conditions of LBP is HVLA relatively contraindicated?
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spondylolisthesis, herniated nucleus, pulposus
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